Title : The effectiveness of the management of osteoporotic spinal compression fractures
Abstract:
Background: In the UK, there is an increasing age in the population, having a direct correlation with increasing prevalence of osteoporotic fractures. Osteoporotic fragility fractures are a huge burden to the NHS with over 300,000 patients presenting with fragility fractures to hospitals in the UK year with an estimated financial burden of £2.2 billion in 2025 (NICE,2017), with an estimated 1.4 million vertebral compression fractures reported worldwide (Guo, 2015). As well as working towards the prevention of fragility fractures of osteoporosis, we must also consider best management for the patients as there is a 53.9% survival rate at 3 years post fracture (Chester, 2022).
Objectives: Investigate the effectiveness of surgical vs non-surgical management for osteoporotic spinal cord compression fractures.
Introduction: There is a huge burden of fragility fractures onto the NHS in the UK, including osteoporotic spinal compression fractures. It is important that these patients are managed in the most effective way, to ensure quality of life after the injury.
The current management of osteoporotic spinal compression fractures include:
1. Operative management including vertebroplasty, kyphoplasty and open surgical reconstruction which may include decompression if indicated. (Garfin, 2001)
2. Conservative management which includes best rest, analgesics / specialist pain centre referral, early mobilisation, bracing and physical therapy. (Prather, 2007).
In the UK, recommended treatment includes non-operative management for anterior spinal column involvement and to consider operative management in those with multiple column involvements. (BMJ, 2023).
Methods: A review of the literature published was conducted following an advanced search on PubMed and Google Scholar in June 2023. Key search terms included ‘osteoporotic spinal compression fractures’, ‘surgical management’, ‘conservative management’. Following title and abstract screening tools, 3 papers were analysed for a full-text overview, to draw conclusions about the management of vertebral compression fractures.
Following this, 3 studies met the inclusion criteria and provided data to allow the inclusion of over 5,000 participants.
Results: According to a systematic review conducted (Guo, 2015), compared with conservative treatment, surgical intervention was more effective in reducing pain and disability on the Roland-Morris disability score. As well as another study (Chester, 2022) drawing conclusions of conservative management leading to uncontrolled back pain and progression of a kyphotic deformity, with a high likelihood of patients having a progression of the vertebral spinal compression fracture in the future, giving a poor prognosis. (Garfin, 2001), another piece of research demonstrated the benefit of vertebroplasty and kyphoplasty (surgical intervention) where 90% of patients reported pain relief and improved mobility within 24 hours, with 95% having reported clinical improvements in their condition.
Conclusions: In conclusion, the review has suggested operative management gives patients the best outcomes when suffered vertebral compression fracture. However, this management often cannot be implemented due to the patient not being suitable for operative management due to several co- morbidities such as dementia within this age group. According to a study (Perreira, 2017), greater clarification is needed within the guidelines for clinicians to make decisions between conservative and surgical management.
